Running On Fumes: Young adults and psychostimulant use disorder. Dr. John Dyben. DHSc, MCAP, CMHP

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1 Running On Fumes: Young adults and psychostimulant use disorder Dr. John Dyben DHSc, MCAP, CMHP Chief Clinical Officer, Origins Behavioral Healthcare

2 Today s Points Non-prescription psychostimulant use amongst young adults Perceptions and consequences Generational cohorts & the Millennials Addressing Failure to Launch

3 A Changing Landscape New synthetic drugs Increase in THC content in pot Dramatically more powerful opiates Prescription drugs

Amongst college students and other young adults, nonmedical use of

4 The Current Scene Alcohol remains the primary chemical leading to substance use disorders but it is often used concurrently with other drugs. Amongst college students and other young adults, nonmedical use of prescription stimulants (NPS) may be the most common form of drug use following alcohol.

5 Nonprescription Use of Stimulants Commonly misused psychostimulants include: dextroamphetamine (Dexedrine) dextroamphetamine/amphetine combination (Adderall) and methylphenidate (Ritalin, Concerta) Sometimes referred to as: Speed, Uppers, Skippy, Kibbles-and-bits, Vitamin R Others?

6 Nonprescription Use of Stimulants Schedule II Most similar to Meth & Cocaine More than 10% of college students regularly. More than 30% in history. Survey of over 1300: Almost 25% using, fewer than 10% have scripts. Inexpensive and easy to access, these drugs are viewed by many as harmless or even helpful.

7 Consequences High Doses: seizures heart failure hyperthermia irregular heartbeat Repeated Use: paranoia/anger convulsions impulsivity impaired judgement psychosis addiction

8 8 What is Addiction? a primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. AAPM, APS, ASAM Liaison Committee on Pain and Addiction (2001)

10 Why take it & why so normal? Reasons for Use: Believe it will help school performance. Families believe it. Weight loss. Drink more. Realities: Doesn t help, might even hurt (only feel like I m doing better) Increased risk for ED and other health problems. Starve the body of nutrients.

11 Generational Cohorts Groups of people born within a given time frame Experienced common events Lives shaped by formational experiences Effects remain through lifespan Relevant for cultural awareness

12 The Millennials Second largest cohort in the general population Raised in a time where violence, terrorism, and drug overdose are normal realities of life. Raised by nurturing parents and drawn to family for safety and security. Global and multicultural Technology and instant communication always part of their lives.

13 Human Development Adolescence is the transition from childhood to adulthood. It extends from the beginnings of sexual maturity to the achievement of independent adult status which is very roughly the ages of Some people continue to function in adolescence well into their 20s.

14 Human Development Five recognized psychosocial indicators of having moved from adolescence to adulthood: Establishing an identity Establishing autonomy Establishing intimacy Becoming comfortable with one's sexuality Achievement

15 Failure to Launch In some cases individuals may enter adolescence but never actually develop the skills for independent living necessary to move beyond adolescence and into adulthood. This is often referred to as failure to launch, and the situation is essentially characterized by remaining stuck in a state of perpetual adolescence.

16 Failure to Launch Risk factors include: Substance abuse in childhood/adolescence Childhood/adolescence traumatic events Family system that does not allow for development of independent living skills.

17 Living at home is not the only indicator of FTL but it is most often a symptom and presents a red flag. It is possible to live outside of parents home and have FTL. The converse is also possible. The key issue here is has one achieved and maintained social independence?

18 Though this issue effects both genders, amongst those 18-34, since 2008 men are more likely to live with parents then with spouse or in cohabitation. Frey (2016) Pew Research Center

19 Barriers to Recovery Patients with this profile seeking treatment for addiction that began in adolescence have a dual concern. First, they must develop skills for living life without drugs and alcohol. On top of this, they must learn essential independent living skills so that they can truly move out of adolescence and into adulthood.

20 Treating This Population FTL occurs in the context of a family system. Addressing FTL necessarily means addressing the system, particularly parents/guardians who are primarily providing accommodations.

21 Family Systems Families have been traditionally seen as a group of more or less independent agents linked by their membership in the family, and any given member's behavior was not necessarily related to the behavior of any other member.

22 Family Systems With such a restricted view of the family, it is entirely likely that a parent might state, "I have two children; my daughter is terrific, but my son is always in trouble. Since I raised them both the same way, there must be something dreadfully wrong with my son."

23 Family Systems By definition, a family system functions because it is a unit, and every family member plays a critical, if not unique, role in the system. As such, it is not possible that one member of the system can change without causing a ripple effect of change throughout the family system. H. Dan Smith, Ed.D., MFT

24 Family Homeostasis Families are dynamic systems and are influenced by changes that occur both within and outside of the family system. Natural tendency of families to behave in such a manner as to maintain a sense of balance, structure, and stability in the face of change. It is a kind of inertia which actually works against change in the system.

25 Treating This Population The big questions: What do you want? What is missing?

26 Treating This Population The big questions: For most, especially as we get older, the answer is Peace. For these young people, the answer that must come first is Identity.

28 Treating This Population Function (this is what you do ) + Purpose (this is how you fit ) + Meaning (this is why it matters ) = Identity (This is who I am.)

29 Function Life skills training: Meal planning and cooking Money management Educational and vocational support services Time management Exercises in responsibility of self-care Service

30 Purpose Interpersonal development: Community living Citizenship Fulfilling family obligations Teamwork Group therapy (early) Service

31 Meaning Exploring the transcendent: Spirituality Love Peace Group therapy (advanced) Service

32 Questions?

33 References Arria, A. M., Caldeira, K. M., Vincent, K. B., O'Grady, K. E., Cimini, M. D., Geisner, I. M.,... & Larimer, M. E. (2017). Do college students improve their grades by using prescription stimulants nonmedically?. Addictive behaviors, 65, Benson, K., Flory, K., Humphreys, K. L., & Lee, S. S. (2015). Misuse of stimulant medication among college students: a comprehensive review and meta-analysis. Clinical Child and Family Psychology Review, 18(1), Elgar, F. J., Craig, W., & Trites, S. J. (2013). Family dinners, communication, and mental health in Canadian adolescents. Journal of Adolescent Health, 52(4), Hedden, S. L. (2015). Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Department of Health & Human Services. Jeffers, A. J., & Benotsch, E. G. (2014). Non-medical use of prescription stimulants for weight loss, disordered eating, and body image. Eating behaviors, 15(3),

34 References Lupi, M., Martinotti, G., & Di Giannantonio, M. (2017). Drunkorexia: an emerging trend in young adults. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 22(4), NIDA. (2018, February 5). Prescription Stimulants. Retrieved from on 2018, May 8 Norris, M. (2018, March 25). Survey finds that 24 percent of University students use Adderall. The Michigan Daily US Department of Justice, Drug Enforcement Administration (2017), 2017 National Drug Threat Assesment. Retrieved from Weyandt, L. L., Marraccini, M. E., Gudmundsdottir, B. G., Zavras, B. M., Turcotte, K. D., Munro, B. A., & Amoroso, A. J. (2013). Misuse of prescription stimulants among college students: A review of the literature and implications for morphological and cognitive effects on brain functioning. Experimental and Clinical Psychopharmacology, 21(5),

35 Dr. John Dyben (561)

teen drug use Percent of 12th-graders Who Used A Substance in the Past Month (Type of Drug & Prevalence): 13% 33% 11% 23%

teen drug use Percent of 12th-graders Who Used A Substance in the Past Month (Type of Drug & Prevalence): 13% 33% 11% 23% teen drug use As kids get older, they often start to question the life lessons they hear from parents and teachers. They become more heavily influenced by the things they see on TV, the Internet and social